Solid organ transplant donors with central nervous system infection

Area of Science:

• Transplant Immunology
• Infectious Diseases
• Neurology

Background:

• Donor-derived infections (DDI) from central nervous system (CNS) pathogens, though uncommon, pose significant risks to organ recipients.
• Reports indicate DDI with CNS pathogens can lead to severe recipient morbidity and mortality.
• The Ad Hoc Disease Transmission Advisory Committee (DTAC) analyzed potential donor-derived disease transmission events (PDDTE) to characterize donors and outcomes related to CNS pathogen DDI.

Purpose of the Study:

• To describe donor characteristics associated with DDI from CNS pathogens.
• To outline recipient outcomes following DDI from CNS pathogens.
• To identify risk factors and warning signs for CNS pathogen transmission from donors.

Main Methods:

• Review of all PDDTE reported between January 2008 and September 2010.
• Identification of cases with suspected CNS infection in either donor or recipient.
• Detailed examination of confirmed donor CNS infections and subsequent recipient infections.

Main Results:

• Ninety-one PDDTE cases with suspected CNS infection were identified.
• Twelve donors had confirmed CNS infections; six transmitted to 10 of 15 recipients.
• Five recipient deaths occurred; implicated pathogens included Balamuthia mandrillaris, Cryptococcus neoformans, LCMV, and West Nile virus.

Conclusions:

• Careful clinical assessment of organ donors is crucial for preventing DDI.
• A high index of suspicion for ambiguous findings suggestive of CNS infection is necessary.
• While risk reduction is possible, complete elimination of DDI from CNS pathogens remains challenging.